Clinical Orthopaedics and Related Research®

, Volume 467, Issue 12, pp 3257–3262 | Cite as

Complications of Recombinant Human BMP-2 for Treating Complex Tibial Plateau Fractures: A Preliminary Report

  • Sreevathsa Boraiah
  • Omesh Paul
  • David Hawkes
  • Matthew Wickham
  • Dean G. Lorich
Symposium: Tribute to Dr. Marshall Urist: Musculoskeletal Growth Factors


Bone morphogenic proteins (BMPs) are potent osteoinductive agents. Their use in fracture surgery is still being studied and the clinical indications are evolving. Heterotopic bone after BMP use in spine surgery is a known complication. While some literature describes the ability of BMP to enhance fracture healing, few articles describe complications of BMP. In tibial plateau fractures, after elevating the cartilage en mass, a subchondral void may be created in these fractures. Structural support provided by bone void-filling agents can be augmented with osteoinduction achieved by BMP. We asked whether heterotopic bone formation would occur more frequently with BMP-2 when used in tibial plateau fractures and whether BMP-2 enhanced the ability to maintain surgically restored subchondral bone integrity. Heterotopic bone developed more frequently in patients receiving BMP (10 of 17) than in patients not receiving BMP (one of 23). Four patients receiving BMP and no patients not receiving BMP underwent removal of heterotopic bone. Maintenance of subchondral bone integrity was similar without and with the use of BMP. BMP is a potent osteoinductive agent; however, when used for an off-label indication in periarticular situations, complications such as heterotopic bone are common and increase reoperation rates.

Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.


Subchondral Bone Heterotopic Ossification Demineralized Bone Matrix Tibial Plateau Fracture Collagen Sponge 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  • Sreevathsa Boraiah
    • 1
  • Omesh Paul
    • 1
  • David Hawkes
    • 2
  • Matthew Wickham
    • 2
  • Dean G. Lorich
    • 1
  1. 1.Department of Orthopaedic SurgeryHospital for Special SurgeryNew YorkUSA
  2. 2.University of Liverpool Medical SchoolLiverpoolUK

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